Healthcare Provider Details

I. General information

NPI: 1497680532
Provider Name (Legal Business Name): ANNA MARIE LEGENDRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CAJUNDOME BLVD
LAFAYETTE LA
70506-4271
US

IV. Provider business mailing address

536 SETTLERS TRACE BLVD APT 8201
LAFAYETTE LA
70508-6197
US

V. Phone/Fax

Practice location:
  • Phone: 337-482-6159
  • Fax:
Mailing address:
  • Phone: 337-541-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: